Transcatheter Correction of Superior Sinus Venosus ASDs
What is the feasibility of covered stent implantation in the superior vena cava (SVC) in management of superior sinus venosus atrial septal defects (SVASDs)?
Review of 48 consecutive SVASD patients referred for correction was performed at a single center. Patients underwent pre-procedural evaluation consisting of cross-sectional imaging and simulation using printed or virtual three-dimensional models.
Of 48 patients evaluated for intervention, transcatheter correction was performed in 25 patients. Of the remaining patients, six were awaiting the procedure at time of manuscript publication, and 17 underwent surgical closure. Surgical closure was performed because of anatomy unsuitable to transcatheter closure in eight, need for concomitant procedures in four, and patient/provider preference in five patients. Balloon test inflation was performed in the anticipated stent landing zone with simultaneous transesophageal echocardiography and pulmonary venography to confirm defect closure and unobstructed pulmonary venous drainage. A 10-zig covered Cheatham stent was deployed with a second, uncovered stent used for anchoring in the SVC in nine patients. The right upper pulmonary vein was protected during stent deployment with a high pressure balloon to prevent pulmonary venous obstruction in four patients. The median follow-up period was 1.4 (interquartile range, 0.8-1.7) years, with no mortality. Stent embolization requiring surgical removal occurred in one patient; another required drainage of hemopericardium. Cardiac computed tomography after 3 months confirmed unobstructed pulmonary venous return. At latest follow-up, a residual shunt was present in one patient.
The authors concluded that transcatheter closure of SVASD may be considered as an alternative to surgery in a substantial number of patients.
This study demonstrated the feasibility of transcatheter closure of SVASD in a carefully selected cohort of patients. The procedure appears technically demanding and requires both test occlusion for pulmonary vein obstruction and sometimes protection of the right upper pulmonary vein with a high pressure balloon at the time of device deployment. The procedure also requires meticulous planning and understanding of the three-dimensional anatomy of each individual patient. As this was a selected group of patients at an experienced center, the results reported here may not be widely generalizable at this time. The procedure shows promise as an alternative to surgery moving forward.
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Pericardial Disease, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Angiography, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Cardiac Surgical Procedures, Cardiology Interventions, Diagnostic Imaging, Echocardiography, Transesophageal, Heart Defects, Congenital, Heart Septal Defects, Atrial, Pericardial Effusion, Phlebography, Pulmonary Circulation, Pulmonary Veno-Occlusive Disease, Stents, Tomography, Vena Cava, Superior
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